Esophagitis and Esophageal Stricture

Craig G. Ruaux, BVSc, PhD, DACVIM (Small Animal)

BASIC INFORMATION The endoscope allows the veterinarian to see foreign bodies, stric- Description tures, or ulcers in the esophagus and also allows biopsy samples The esophagus is a muscular tube that carries swallowed food to be obtained. Examination of the stomach and upper small intes- and water from the mouth to the stomach. The esophagus is very tines may be done at the same time. sensitive to damage from stomach acid, so any medical problem Other tests may be recommended to rule out diseases that cause leading to excess stomach acid in the esophagus can cause inflam- similar signs and to determine the underlying causes of any acid mation, which is called esophagitis. In people, the same condition reflux present. is called heartburn or acid reflux disease . Some animals with severe esophagitis will later form an esoph- TREATMENT AND FOLLOW-UP ageal stricture—scarring that reduces the esophageal diameter. When the diameter of the esophagus is reduced by a stricture, the Treatment Options animal is less able to swallow food and water. The esophagus is very susceptible to damage from stomach acid, Causes so strong antacid medications are commonly prescribed. Other The esophagus can be exposed to stomach acid during profuse medications that help protect the esophagus from damage may vomiting or gastric reflux, from eating high-fat foods, or during also be started. Antibiotics and antifungal agents may be given for or after an anesthetic procedure. Esophagitis can also occur with certain infections and for aspiration pneumonia. If regurgitation some forms of food allergy, certain infections, and after trauma or vomiting is occurring, other drugs are administered to decrease from ingestion of foreign bodies. Structural abnormalities of these signs. Food is given in small meals, and usually softer foods the esophagus, such as a hernia, may predispose the animal to are more readily accepted. esophagitis. Certain oral medications and the ingestion of irritat- Animals with an esophageal stricture may require breakdown ing materials can also cause esophagitis. of the stricture. Strictures are usually treated by passing special water-filled balloon catheters into the esophagus while the animal Clinical Signs is anesthetized. The catheter is passed into the area of the stricture Esophagitis can be painful, causing affected dogs and cats to lose and slowly expanded. Several such treatments may be necessary. their appetite. If the animal has difficulty swallowing, drooling of Your veterinarian may recommend referral to a specialist who can salvia and regurgitation of food or water may be seen. perform this procedure. When an esophageal stricture is present, food and water are less Animals with severe esophageal damage may have a feeding able to travel to the stomach, and the animal may act very hungry. tube placed into the stomach that allows the animal to receive food Water and very soft food may be able to pass through the stricture, and water without passing them through the esophagus. The feed- but harder foods, such as kibble or biscuits, may be regurgitated. ing tube usually stays in place for at least 2 weeks. Other therapies A possible complication of both esophagitis and esophageal may be indicated, depending on the presence of any underlying stricture is aspiration pneumonia, which develops when food or liq- cause of the esophagitis. uids are inhaled into the lungs. If aspiration pneumonia is present, coughing, fever, lethargy, and halitosis (bad breath) may occur. Follow-up Care Uncomplicated cases of esophagitis are usually rechecked 7-10 Diagnostic Tests days after starting therapy and then periodically for several Initially plain x-rays of the neck and chest are often done to months. More intensive monitoring is needed in cases with severe assess the esophagus. It is common for more specialized x-rays esophagitis or strictures and after insertion of a feeding tube. to be taken after the patient has been given an oral contrast mate- Prognosis rial that shows up white on an x-ray. This procedure is called an Prognosis for recovery from uncomplicated esophagitis is usually esophagram, and it is particularly useful if an esophageal stricture good. Prolonged treatment may be required in some cases. Severe is suspected. cases have a more guarded (uncertain) prognosis, particularly if In some animals, esophagoscopy, which is examination of aspiration pneumonia is present or a feeding tube is needed. Many the interior of the esophagus with a rigid or flexible endoscope, animals with esophageal strictures return to more normal eating is needed. Esophagoscopy is done with the animal anesthetized. and esophageal function with treatment.